- 60-65% of Americans are in some kind of federally supported and run health care system: Medicare, Medicaid, Veteran's Administration, SCHIP, Federally elected officials' health care system.
- Money for these programs comes from one source--taxes--and pays from one source.
- Insurance is the most expensive things we buy in our lifetime.
- Some states (Massachusetts, Oregon) have tried to create solutions but they haven't been able to control cost.
- Uninsured are not the center; they are result of the critical problems
- Three most critical problems in current system:
LACK OF FAIRNESS
CURRENT SYSTEM IS UNDERFUNDED
All are equal
All in one system
COST problem contains this subset of issues:
- Insurance Companies
- Practice Inefficiencies (Doctors and Hospitals)
- Defensive Medicine
- Drugs and Medical Devices
- Individual Responsibility
1. Insurance Companies
- Should be independent of government, publicly funded, privately run (Congress will resist this).
- Simplest solution is to extend Medicare to all with a private, non-profit governing authority.
- Alternative system: Government delegates insurance to non-profit private companies who compete for business.
Companies must give same policy to everyone.
Companies make money on other types of insurance (house, car, etc.)
Tax money goes toward premium based on a sliding scale, based on income.
Currently, 2/3 of income taxes are paid by the top 10% of population.
2. Practice Inefficiencies
- Fee for service for doctors needs to be eliminated; currently, doctors paid for quantity of services not quality (If you do more, you make more)
- Bundled payments needed (examples: Mayo, Cleveland, Kaiser)
3. Defensive Medicine (malpractice insurance problem)
- Less than .6% of the cost of medical care
- Hidden costs of malpractice insurance: unnecessary testing
Need to change tort law
If one is injured in health care system, cost is paid for from public fund
Make system safer
Re-educate doctors and assess performance
4. Drugs and Medical Devices
- Create an oversight board that controls costs
- Bundled payments
5. Lack of Manpower among primary care providers
- Need to support education for primary care providers
- Increase numbers of nurse practitioners
6. Personal Responsibility
- Healthy nutrition, exercise, healthy practices
- Provide premiums for not smoking, working out, etc.
These ideas are based on the Dutch health care system.